Contraception after Chidbirth

Contraception should be considered by the new parents soon after birth. Until your baby is 21 days old you cannot become pregnant. After that, the risk of falling pregnant again starts. If you are breast feeding your baby, it gives some protection. However, you would still need to discuss with your doctor for safer contraceptive choices. There are many choices available for women. If you want to have more children, choose an option that is easily stopped so your fertility returns to normal. If you feel your family is complete, long-acting methods or sterilisation should be considered.

When will I get my periods again?

Periods normally return about four to ten weeks after your baby's birth if you are bottle-feeding, or combining breast and bottle. If you are breast-feeding then your periods may not start for few months. For some women this might take up-to 6 months or more.

Can Breast feeding protect me from pregnancy?

During breast feeding, a hormone called Prolactin is produced by the body, which stimulates the production of milk. Prolactin also blocks the release of the hormones responsible for ovulation. This means that you are less likely to become pregnant whilst you are breast-feeding. You must remember that it is still not fool proof method of contraception.

You can use breast-feeding (the lactation amenorrhoea method) for contraception if you are:

  • Fully breast-feeding AND
  • Six months or less since delivery AND
  • Not having periods


The chance of falling pregnant with Lactational amenorrhoea method (LAM) is 2 in 100. That means, 2 women in every 100 using this will become pregnant within those six months. Hence, your doctor may advise you to use some contraception in addition to breast-feeding, to reduce the risk of an unplanned pregnancy. There are methods available that will not affect the milk production or harm the baby.

How soon can I have sex again?

You can resume sexual activity whenever you and your partner feel ready to. If you have had a difficult delivery, it may take a while to feel ready, both physically and emotionally. If you have had episiotomy (stitches), they are usually dissolvable stitches, so will not need removing. If you are having any discomfort from these then you should see your doctor. Some women find they need to use some vaginal lubricant if they feel more dry than normal.

How to choose a contraceptive method?

When you choose a method of contraception you need to think about:

  • Effectiveness of the method
  • Possible risks and side-effects.
  • Plans for future pregnancies.
  • Personal preference.
  • Co-existing medical conditions


Types of contraceptive methods

The types of contraceptives can be divided into short-acting, long-acting and permanent. If you are choosing a contraceptive for spacing (the gap between two pregnancies), then you should consider a short-acting contraceptive.

Brief information about various contraceptive methods:

Short-acting contraceptives

Combined oral contraceptive pill (COCP)

It is a very popular and effective method. It contains Oestrogen and Progestogen and works mainly by stopping egg production (ovulation). It is 99% effective. That means, less than 1 in 100 women can become pregnant even with correct usage every year.

  • Advantages - It is very effective. Side-effects are not very common. It helps to ease painful and heavy periods. When you stop taking it, your fertility returns quickly.
  • Some disadvantages - There is a small risk of thrombosis (blood clots). Some women have minor side-effects like nausea etc. It can't be used by women with certain medical conditions, such as uncontrolled high blood pressure, excessive obesity and migraine.

 

The COCP can be started from 21 days after the birth. However, it is not recommended if you are breast-feeding. Please discuss with your doctor for further information.

Progestogen-only pill (POP)

The POP used to be called the 'mini-pill'. It contains just a progestogen hormone. It works mainly by causing a plug of mucus in the neck of the womb (cervix) that blocks the entry of the sperm. It also thins the lining of the womb, making it less likely the egg will implant. A specific type called cerazette stops ovulation as well which makes it more effective than the other varieties.

It is more than 99% effective if used correctly. It is commonly taken if the COCP is not suitable, such as in breast-feeding women, smokers over the age of 35 and some women with migraine.

  • Some advantages - Serious risks are less common than COCP. When you stop taking it, you quickly become fertile again.
  • Some disadvantages - Some women have side-effects. Periods may be quite irregular. Most types are not quite as reliable as the COCP.

The POP can be started from 21 days after the birth. You can use this type of pill even if you are breast feeding. However, you need to remember to take it at the same time every day because, if you take a pill more than three hours later than usual time, your chances of failure with the method increases. (Window period is 12 hours for Cerazette).

Barrier methods

Barrier contraceptives work by preventing sperm entry into the uterus. These include male condoms, the female condom, diaphragms and caps. If used properly about 2 women in 100 will become pregnant. Other barrier methods are slightly less effective than this.

  • Some advantages - Condoms help protect from sexually transmitted infections. No serious medical risks or side-effects. Fertility is not affected by these methods.
  • Some disadvantages - They need to be used properly every time you have sex. Male condoms occasionally split or can come off with improper use. Reliability is less compared to other methods.


Natural methods

This involves monitoring the natural fertility cycle and avoiding intercourse during unsafe days. It requires commitment and regular checking of fertility indicators such as body temperature and cervical secretions. There are equipments available to help you monitor the unsafe days (Ovulation thermometers, Cycle beads etc). Between 1 and 9 women per 100 will become pregnant using this method.

  • Some advantages - No side-effects or medical risks.
  • Some disadvantages - Fertility awareness needs proper instruction and takes 3-6 menstrual cycles to learn properly. This is not as reliable as other methods.

The lactation amenorrhoea method (LAM) is suitable for the first six months after having a baby, if you are only breast-feeding and do not have a period. 2 women in 100 will conceive during those six months using this method.

Long-acting contraceptives

These are more suitable for women who do not want to get pregnant again or looking for a spacing method for a few years.

Contraceptive injection

This contains a progestogen hormone which slowly releases into the body. It works by preventing ovulation and also has similar actions as the POP. An injection is needed every 8-12 weeks. It is very effective. Fewer than 4 women in every 1000 using it will become pregnant after two years.

  • Some advantages - It is very effective. Gives protection for 12 weeks, so does need everyday remembering like pills
  • Some disadvantages - periods may become irregular (but often lighter or stop all together). After stopping, there may be a delay in your return to normal fertility for several months. Some women are prone to get bad side effects and if they do occur, may persist for longer than 8-12 weeks.

It is usually advisable to start the contraceptive injection six weeks after child birth because you may get heavy and irregular bleeding. However, it is possible to start it earlier if there are no other alternatives suitable for you.

Intrauterine contraceptive device (IUCD)

A 'T' shaped device made of plastic and copper is put into the womb. It lasts for five or more years. Fewer than 2 women in 100 will become pregnant with IUD. It works mainly by stopping the egg and sperm from meeting. It may also prevent the fertilised egg from attaching to the lining of the uterus ( prevents implantation of the fertilised egg). The copper also has a spermicidal effect (kills sperm).

  • Some advantages - It is very effective. Fertility returns quickly after removal. Does not need everyday remembering like pills.
  • Some disadvantages - Periods may become heavier or more painful.

An IUCD can usually be fitted 6-8 weeks after childbirth or sometimes, it can even be fitted immediately (PPIUD)

Intrauterine system (IUS)

It is very similar to IUD. A plastic device that contains a progestogen hormone is put into the uterus. There is no copper used in the device. The progestogen is released at a slow but constant rate. Less than 1 woman in 100 will become pregnant with five years of use of this method. It works by making the lining of your womb thinner so it is less likely to accept a fertilised egg. It also thickens the mucus from the neck of your womb. It is also used to control heavy bleeding in some people (menorrhagia).

  • Some advantages - It is very effective. Fertility returns quickly once it is removed. Periods may become light or stop altogether.
  • Some disadvantages - Side-effects as with other progestogen methods such as the POP, implant and injection may occur. However, they are much less likely, as little amount of hormone gets into the bloodstream.

An IUS can usually be fitted 6-8 weeks after giving birth.

When can emergency contraception be used?

Emergency contraception can be used at any time if you had intercourse without using contraception. Also, if there was an accident like a split condom or if you missed taking your usual contraceptive pills.

  • Emergency contraception pills - are usually very effective if started within 72 hours of unprotected intercourse. They can be bought at pharmacies. An emergency contraception pill works either by preventing ovulation or by preventing the fertilised egg from implanting in the womb.
  • An IUCD - inserted by a doctor or nurse, can be used for emergency contraception up to five days after unprotected sex.

You will not need emergency contraception if you have unprotected sex within 21 days of having your baby. You cannot get pregnant so soon after childbirth.

Sterilisation - permanent contraception method

Vasectomy (male sterilisation) stops sperm travelling from the testes. Female sterilisation prevents the egg from travelling along the Fallopian tubes to meet a sperm. Both involve an operation. Both methods are very effective. Vasectomy is easier as it can be done under local anaesthetic. These methods are done when the couple feel that their family is complete. They are difficult to reverse, so you should be very sure before deciding on sterilisation.

  • Some advantages - very effective. No further contraception is required.
  • Some disadvantages - very difficult to reverse. General anaesthetic may be used for female sterilisation.

If you have Caesarean section, you can ask your doctor to sterilise you at the same time, if you are very sure of your decision or you can also get it done later.


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